M A Bourguiba, M Gharbi, M Ghalleb, A Ben Taher, F Souai, Y Bensafta, S Sayari, M Ben Moussa
General Surgery department A, Charles Nicolle Teaching Hospital, Faculty of Medicine, Uiversity of Tunis el Manar, Tunisia.
Int J Surg Case Rep. 2017;37:254-256. doi: 10.1016/j.ijscr.2017.06.053. Epub 2017 Jul 8.
Enterovesical fistulas usually result from diverticulitis, Crohn's disease, or colorectal cancer. A perforated Meckel's diverticulum can exceptionally result in an vesico-diverticulum fistula, as noted in only seven previously reported cases.
A 35-year old Arabic male, quadriplegic,who presented epigastralgia evolving for a week, associated with abdominal distension and cloudy urine. On examination he was feverish (38.5°C), dehydrated with tenderness in the entire distended abdomen; rectal examination revealed a hypotonic sphincter with no other abnormality. After investigations, acute peritonitis diagnosis was retained. Exploratory laparotomy revealed a vesico-diverticular fistula resulting from a performed Meckel's diverticulum. Diverticulectomy, ileostomy and bladder sutures were performed after peritoneal cleansing. The postoperative course was uneventful. The anatomo-pathological examination confirmed the diagnosis of a perforated Meckel's diverticulum that did not contain ectopic gastric or pancreatic tissue.
Vesico-diverticular fistula resulting from a perforated Meckel's diverticulum is a rare complication. To our knowledge, this is only the fourth reported case which is not associated to inflammatory bowel disease.
膀胱肠道瘘通常由憩室炎、克罗恩病或结直肠癌引起。如仅7例先前报道病例所示，穿孔的梅克尔憩室可罕见地导致膀胱憩室瘘。
一名35岁的阿拉伯男性四肢瘫痪患者，上腹部疼痛持续一周，伴有腹胀和尿液浑浊。检查发现他发热（38.5°C），脱水，全腹胀并有压痛；直肠检查显示括约肌张力减退，无其他异常。经过检查，确诊为急性腹膜炎。剖腹探查发现膀胱憩室瘘由穿孔的梅克尔憩室引起。在进行腹膜清洗后，实施了憩室切除术、回肠造口术和膀胱缝合术。术后过程顺利。解剖病理学检查证实为穿孔的梅克尔憩室，其中不含异位胃或胰腺组织。
穿孔的梅克尔憩室导致膀胱憩室瘘是一种罕见的并发症。据我们所知，这是第四例报道的与炎症性肠病无关的病例。
